,,ii  #aai? ,,congress  #a/ ,session    
,s4 #adaj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #aj1 #bjbe,ms4  
,klobu*> 7= h]self & ,mr4 ,m>%all7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to provide = heal? cov]age )
 no co/-%>+ = additional brea/ scre5+s =
 c]ta9 individuals at great] risk =     
brea/ canc]4  #a4 ,%ort title ,?is ,act 
may be cit$ z ! ,f9d ,x ,e>ly ,act4  #b4
 ,cov]age ) no co/-%>+ = additional     
brea/ scre5+s = c]ta9 individuals at    
great] risk = brea/ canc]  7a7 ,cov]age 
"u gr\p heal? plans & gr\p & individual 
heal? insurance cov]age  7#a7 ,9 g5]al  
,section #bgac7;a7 ( ! ,public ,heal?   
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ac7;a77 is am5d$-- 7,a7 9      
p>agraph 7#b71 by /rik+ & at ! end2     
7,b7 9 p>agraph 7#c71 by /rik+ ! p]iod  
at ! end & ins]t+ a semicolon2  7,c7 9  
p>agraph 7#d71 by /rik+ ! p]iod at ! end
 & ins]t+ & z describ$ 9 subp>agraph    

7,e72 &2  7,d7 by r$esignat+ p>agraphs  
7#a7 ?r\gh 7#e7 z subp>agraphs 7,a7     
?r\gh 7,e71 respectively1 & adju/+ !    
m>g9s accord+ly2  7,e7 by /rik+ !       
subsection designation & head+ & all t  
foll[s ?r\gh ,a gr\p heal? plan & ins]t+
 ! foll[+3  7a7 ,requirem5ts  7#a7 ,9   
g5]al ,a gr\p heal? plan  2  7,f7 9 !   
undesignat$ matt] foll[+ subp>agraph    
7,e7 ( p>agraph 7#a7 7z s r$esignat$71  
by /rik+ ,no?+ 9 ?is subsection & ins]t+
 ! foll[+3  7#c7 ,rule ( con/ruction    
,no?+ 9 ?is subsection  2  7,g7 9       
subp>agraph 7,e7 ( p>agraph 7#a7 7z s   
r$esignat$71 by /rik+ 7,e7 = ! purposes 
( ?is ,act1 & ins]t+ ! foll[+3  7#b7    
,recomm5dations ,= ! purposes ( ?is     
,act1  2  7,h7 9 p>agraph 7#a7 7z s     
r$esignat$71 by add+ at ! end ! foll[+3 
7,e7 7i7 ) respect to an individual :o  
is at increas$ risk ( brea/ canc] 7z    
det]m9$ 9 accordance ) ! mo/ rec5t      
applicable ,am]ican ,college (          
,radiology ,appropriat5ess ,crit]ia or !
 mo/ rec5t applicable guidel9es ( !     

,national ,compreh5sive ,canc] ,network7
 or ) het]og5e\sly or extremely d5se    
brea/ tissue 7z def9$ by ! ,brea/ ,imag+
 ,report+ & ,data ,sy/em e/abli%$ by !  
,am]ican ,college ( ,radiology71 scre5+ 
& diagno/ic imag+ 7) no limitation      
appli$ on frequ5cy7 = ! detection (     
brea/ canc]1 includ+ #b;,d or #c;,d     
mammograms1 brea/ ultras\nds1 brea/     
magnetic resonance imag+1 molecul> brea/
 imag+1 or o!r te*nologies 7z det]m9$ 9 
accordance ) su* applicable crit]ia or  
guidel9es72 &  7ii7 ) respect to an     
individual :o is n describ$ 9           
subp>agraph 7,a7 & :o is det]m9$ by a   
heal? c>e provid] 79 accordance ) su*   
mo/ rec5t applicable crit]ia or         
guidel9es7 to require scre5+ or         
diagno/ic brea/ imag+ by reason (       
factors1 includ+ age1 race1 e?nicity1 or
 p]sonal or family m$ical hi/ory1 scre5+
 & diagno/ic imag+ 7) no limitation     
appli$ on frequ5cy7 = ! detection (     
brea/ canc]1 includ+ #b;,d or #c;,d     
mammograms1 brea/ ultras\nds1 brea/     

magnetic resonance imag+1 molecul> brea/
 imag+1 or o!r te*nologies 7z det]m9$ 9 
accordance ) su* applicable crit]ia or  
guidel9es74  4  7#b7 ,effective date ,! 
am5dm5ts made by p>agraph 7#a7 %all     
apply ) respect to plan ye>s beg9n+ on  
or aft] ,janu>y #a1 #bjbf4  7#c7        
,application to gr&fa!r$ heal? plans    
,section #abea7;a77#d77;,a7 ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjaa7;a77#d77;,a77 is       
am5d$-- 7,a7 by /rik+ title7 & ins]t+   
title1 or z add$ aft] ! date ( !        
enactm5t ( ?is ,act72  7,b7 by          
r$esignat+ clause 7iv7 z clause 7v72 &  
7,c7 by ins]t+ aft] clause 7iii7 !      
foll[+3  7iv7 ,section                  
#bgac7;a77#a77;,e7 7relat+ to scre5+ &  
diagno/ic imag+ = ! detection ( brea/   
canc]74  4  7b7 ,cov]age "u ,m$ic>e     
7#a7 ,9 g5]al ,section                  
#ahfa7;ddd77#a77;,b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciex7ddd77#a77;,b77 is am5d$-- 7,a7 by
 /rik+ 7,b7 recomm5d$ & ins]t+ 7,b77i7  

recomm5d$2  7,b7 by /rik+ ,task ,=ce2 & 
& ins]t+ ,task ,=ce2 or2 &  7,c7 by add+
 at ! end ! foll[+ new clause3  7ii7    
beg9n+ on ,janu>y #a1 #bjbf1 9 addition 
to any o!r items or s]vices describ$ 9  
?is p>agraph1 scre5+ & diagno/ic imag+  
7) no limitation appli$ on frequ5cy7 = !
 detection ( brea/ canc]1 includ+ #b;,d 
or #c;,d mammograms1 brea/ ultras\nds1  
brea/ magnetic resonance imag+1 molecul>
 brea/ imag+1 or o!r te*nologies 7z     
det]m9$ 9 accordance ) ! mo/ rec5t      
applicable ,am]ican ,college (          
,radiology ,appropriat5ess ,crit]ia or !
 mo/ rec5t applicable guidel9es ( !     
,national ,compreh5sive ,canc] ,network7
 =-- 7,i7 an individual :o is at        
increas$ risk ( brea/ canc] 7z det]m9$ 9
 accordance ) su* applicable crit]ia or 
guidel9es7 or ) het]og5e\sly or         
extremely d5se brea/ tissue 7z def9$ by 
! ,brea/ ,imag+ ,report+ & ,data ,sy/em 
e/abli%$ by ! ,am]ican ,college (       
,radiology72 &  7,,ii7 an individual :o 
is n describ$ 9 subclause 7,i7 & :o is  

det]m9$ by a heal? c>e provid] 79       
accordance ) su* mo/ rec5t applicable   
crit]ia or guidel9es7 to require su*    
scre5+ or diagno/ic brea/ imag+ by      
reason ( factors det]m9$ by ! ,secret>y1
 includ+ age1 race1 e?nicity1 or p]sonal
 or family m$ical hi/ory2 &  4  7#b7    
,application ( no co/-%>+ "u ,m$ic>e    
advantage plans ,section                
#aheb7;a77#a77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#bb7;a77#a77;,b77 is am5d$-- 7,a7
 9 clause 7iv7-- 7i7 by r$esignat+      
subclause 7,,viii7 z subclause 7,,ix72 &
  7ii7 by ins]t+ aft] subclause 7,,vii7 
! foll[+3  7,,viii7 ,beg9n+ on ,janu>y  
#a1 #bjbf1 scre5+ & diagno/ic imag+ &   
o!r te*nologies describ$ 9 section      
#ahfa7;ddd77#a77;,b77ii7 furni%$ to an  
individual describ$ 9 su* section4  2 & 
7,b7 9 clause 7v71 by /rik+ & 7,,vi7 &  
ins]t+ 7,,vi71 & 7,,viii74  7c7 ,cov]age
 "u ,m$icaid  7#a7 ,9 g5]al ,section    
#aije7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;d7a77 is am5d$--   

7,a7 9 p>agraph 7#d7-- 7i7 by /rik+ 2 & 
7,d7 & ins]t+ 2 7,d72  7ii7 by /rik+ 2 &
 7,e7 & ins]t+ 2 7,e72  7iii7 by /rik+ 2
 & 7,f7 & ins]t+ 2 7,f72 &  7iv7 by     
ins]t+ be=e ! semicolon at ! end !      
foll[+3 2 & 7,g77i7 ) respect to an     
individual :o is at increas$ risk (     
brea/ canc] 7z det]m9$ 9 accordance ) ! 
mo/ rec5t applicable ,am]ican ,college (
 ,radiology ,appropriat5ess ,crit]ia or 
! mo/ rec5t applicable guidel9es ( !    
,national ,compreh5sive ,canc] ,network7
 or ) het]og5e\sly or extremely d5se    
brea/ tissue 7z def9$ by ! ,brea/ ,imag+
 ,report+ & ,data ,sy/em e/abli%$ by !  
,am]ican ,college ( ,radiology71 9      
addition to any o!r item or s]vice      
describ$ 9 ?is subsection1 scre5+ &     
diagno/ic imag+ 7) no limitation appli$ 
on frequ5cy7 = ! detection ( brea/      
canc]1 includ+ #b;,d or #c;,d           
mammograms1 brea/ ultras\nds1 brea/     
magnetic resonance imag+1 molecul> brea/
 imag+1 or o!r te*nologies 7z det]m9$ 9 
accordance ) su* applicable crit]ia or  

guidel9es72 & 7ii7 ) respect to an      
individual :o is n describ$ 9 clause 7i7
 & :o is det]m9$ by a heal? c>e provid] 
79 accordance ) su* mo/ rec5t applicable
 crit]ia or guidel9es7 to require scre5+
 or diagno/ic brea/ imag+ by reason (   
factors1 includ+ age1 race1 e?nicity1 or
 p]sonal or family m$ical hi/ory1 scre5+
 & diagno/ic imag+ 7) no limitation     
appli$ on frequ5cy7 = ! detection (     
brea/ canc]1 includ+ #b;,d or #c;,d     
mammograms1 brea/ ultras\nds1 brea/     
magnetic resonance imag+1 molecul> brea/
 imag+1 or o!r te*nologies 7z det]m9$ 9 
accordance ) su* applicable crit]ia or  
guidel9es72 &  7,b7 9 p>agraph 7#ac71 9 
! matt] prec$+ subp>agraph 7,a71 by     
ins]t+ 7o!r ?an an item or s]vice = :i* 
m$ical assi/ance is provid$ pursuant to 
p>agraph 7#d77;,g77 aft] s]vices4  7#b7 
,no co/-%>+ = c]ta9 brea/ canc] scre5+ &
 diagno/ic imag+  7,a7 ,9 g5]al         
,subsections 7a77#b7 & 7b77#b7 ( section
 #aiaf ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acifo7 are ea* am5d$-- 7i7 9 

subp>agraph 7,i71 by /rik+ or at ! end2 
7ii7 9 subp>agraph 7,j71 by /rik+ at !  
end 2 & & ins]t+ 1 or2 &  7iii7 by add+ 
at ! end ! foll[+ subp>agraph3  7,k7 )  
respect to an individual describ$ 9     
clause 7i7 or 7ii7 ( section            
#aije7;a77#d77;,g71 scre5+ & diagno/ic  
imag+ & o!r te*nologies describ$ 9 su*  
clause 7i7 or 7ii71 respectively2 &  4  
7,b7 ,application to alt]native co/-%>+ 
,section #aiaf;,a7b77#c77;,b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acifo-#a7;b77#c77;,b77 is am5d$ by add+
 at ! end ! foll[+ new clause3  7xv7 ,) 
respect to an individual describ$ 9     
clause 7i7 or 7ii7 ( section            
#aije7;a77#d77;,g71 scre5+ & diagno/ic  
imag+ & o!r te*nologies describ$ 9 su*  
clause 7i7 or 7ii71 respectively4  4    
7#c7 ,inclusion 9 b5*m>k cov]age        
,section #aicg7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifu-#g7;b77 is  
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#i7 ,cov]age ( c]ta9 brea/  
canc] scre5+ & diagno/ic imag+ = c]ta9  

individuals ,not)/&+ ! previ\s          
provisions ( ?is section1 a ,/ate may n 
provide = m$ical assi/ance ?r\gh        
enrollm5t ( an individual ) b5*m>k      
cov]age or b5*m>k-equival5t cov]age "u  
?is section unless su* cov]age includes 
m$ical assi/ance1 ) respect to an       
individual describ$ 9 clause 7i7 or 7ii7
 ( section #aije7;a77#d77;,g71 = scre5+ 
& diagno/ic imag+ & o!r te*nologies     
describ$ 9 su* clause 7i7 or 7ii71      
respectively4  4  7#d7 ,effective date  
7,a7 ,9 g5]al ,except z provid$ 9       
subp>agraph 7,b71 ! am5dm5ts made by ?is
 subsection %all take effect on ,janu>y 
#a1 #bjbf4  7,b7 ,delay p]mitt$ if ,/ate
 legislation requir$ ,9 ! case ( a ,/ate
 plan approv$ "u title ,,xix ( ! ,social
 ,security ,act :i* ! ,secret>y ( ,heal?
 & ,human ,s]vices det]m9es requires    
,/ate legislation 7o!r ?an legislation  
appropriat+ funds7 9 ord] = ! plan to   
meet ! additional requirem5ts impos$ by 
?is section1 ! ,/ate plan %all n be     
reg>d$ z fail+ to comply ) ! requirem5ts

 ( su* title solely on ! basis ( !      
failure ( ! plan to meet su* additional 
requirem5ts be=e ! fir/ day ( ! fir/    
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t ends aft] ! #a-ye> p]iod  
beg9n+ ) ! date ( ! enactm5t ( ?is      
section4 ,= purposes ( ! prec$+ s5t5ce1 
9 ! case ( a ,/ate t has a #b-ye>       
legislative session1 ea* ye> ( ! session
 is deem$ to be a sep>ate regul> session
 ( ! ,/ate legislature4  7d7 ,cov]age & 
elim9ation ( co/-,%>+ "u ,,tric>e  7#a7 
,cov]age ,title #aj1 ,unit$ ,/ates      
,code1 is am5d$-- 7,a7 9 section        
#ajgd;d7a71 by add+ at ! end ! foll[+   
new p>agraph3  7#c7 ,any memb] or =m]   
memb] ( ! uni=m$ s]vices :o is entitl$  
to m$ical c>e "u section #ajgd or       
#ajgd;a ( ?is title & is an individual  
describ$ 9 subp>agraph 7,b7 ( section   
#ajgi7;a77#bj7 ( ?is title %all also be 
entitl$ to ! items & s]vices describ$ 9 
subp>agraph 7,a7 ( su* section 7subject 
to ! same limitations specifi$ 9 su*    

subp>agraph71 z "p ( su* m$ical c>e4  2 
&  7,b7 9 section #ajgi7;a71 by add+ at 
! end ! foll[+ new p>agraph3  7#bj7 7,a7
 ,scre5+ & diagno/ic imag+ 7) no        
limitation appli$ on frequ5cy7 = !      
detection ( brea/ canc]1 includ+ #b;,d  
or #c;,d mammograms1 brea/ ultras\nds1  
brea/ magnetic resonance imag+1 molecul>
 brea/ imag+1 or o!r te*nologies 7z     
det]m9$ 9 accordance ) ! mo/ rec5t      
applicable crit]ia or guidel9es describ$
 9 subp>agraph 7,b771 %all be provid$ if
 ! pati5t is an individual describ$ 9   
subp>agraph 7,b74  7,b7 ,an individual  
describ$ 9 ?is subp>agraph is-- 7i7 an  
individual :o is at increas$ risk (     
brea/ canc] 7z det]m9$ 9 accordance ) ! 
mo/ rec5t applicable ,am]ican ,college (
 ,radiology ,appropriat5ess ,crit]ia or 
! mo/ rec5t applicable guidel9es ( !    
,national ,compreh5sive ,canc] ,network7
 or ) het]og5e\sly or extremely d5se    
brea/ tissue 7z def9$ by ! ,brea/ ,imag+
 ,report+ & ,data ,sy/em e/abli%$ by !  
,am]ican ,college ( ,radiology72 or     

7ii7 an individual :o is n describ$ 9   
clause 7i7 & :o is det]m9$ by a heal?   
c>e provid] 79 accordance ) su* mo/     
rec5t applicable crit]ia or guidel9es7  
to require scre5+ or diagno/ic brea/    
imag+ by reason ( factors includ+ age1  
race1 e?nicity1 or p]sonal or family    
m$ical hi/ory4  4  7#b7 ,elim9ation (   
co/-%>+ ,su* title is fur!r am5d$-- 7,a7
 9 section #ajge;a1 by add+ at ! end !  
foll[+ new subsection3  7d7 ,elim9ation 
( co/-,%>+ = c]ta9 brea/ canc]-,relat$  
items & s]vices ,not)/&+ any o!r        
provision ( ?is section1 co/-%>+        
requirem5ts may n be impos$ or collect$ 
) respect to any b5efici>y enroll$ 9    
,,tric>e ,prime = any item or s]vice    
describ$ 9 subp>agraph 7,a7 ( section   
#ajgi7;a77#bj7 ( ?is title provid$ "u   
,,tric>e ,prime1 9 accordance ) !       
limitations specifi$ 9 su* subp>agraph1 
if ! b5efici>y is an individual describ$
 9 subp>agraph 7,b7 ( su* section4  2   
7,b7 9 section #ajge7;c71 by add+ at !  
end ! foll[+ new p>agraph3  7#e7        

,not)/&+ any o!r provision ( ?is        
section1 co/-%>+ requirem5ts may n be   
impos$ or collect$ ) respect to any     
b5efici>y enroll$ 9 ,,tric>e ,select =  
any item or s]vice describ$ 9           
subp>agraph 7,a7 ( section              
#ajgi7;a77#bj7 ( ?is title provid$ "u   
,,tric>e ,select1 9 accordance ) !      
limitations specifi$ 9 su* subp>agraph1 
if ! b5efici>y is an individual describ$
 9 subp>agraph 7,b7 ( su* section4  2 & 
7,c7 9 section #ajhf1 by add+ at ! end !
 foll[+ new subsection3  7j7 ,not)/&+   
any o!r provision ( ?is section1 co/-%>+
 may n be impos$ or collect$ "u a plan  
contract$ = "u subsection 7a7 ) respect 
to any individual describ$ 9 subp>agraph
 7,b7 ( section #ajgi7;a77#bj7 ( ?is    
title = an item or s]vice describ$ 9    
subp>agraph 7,a7 ( su* section & provid$
 9 accordance ) ! limitations specifi$ 9
 su* subp>agraph4  4  7#c7 ,effective   
date ,! am5dm5ts made by ?is subsection 
%all take effect on ,janu>y #a1 #bjbf4  
7e7 ,cov]age & elim9ation ( co/-,%>+ )  

respect to vet]ans  7#a7 ,cov]age &     
elim9ation ( co/-%>+ ,sub*apt] ,,ii (   
*apt] #ag ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by ins]t+ aft] section  
#agbj;,j ! foll[+ new section3  #agbj,k4
 ,brea/ scre5+s = c]ta9 individuals at  
increas$ risk = brea/ canc]  7a7        
,cov]age ( items & s]vices  7#a7        
,cov]age ,! ,secret>y %all furni% to a  
vet]an describ$ 9 p>agraph 7#b7 scre5+ &
 diagno/ic imag+ 7) no limitation appli$
 on frequ5cy7 = ! detection ( brea/     
canc]1 includ+ #b;,d or #c;,d           
mammograms1 brea/ ultras\nds1 brea/     
magnetic resonance imag+1 molecul> brea/
 imag+1 or o!r te*nologies 7z det]m9$ 9 
accordance ) ! mo/ rec5t applicable     
crit]ia or guidel9es describ$ 9 su*     
p>agraph7 pursuant to ?is section4  7#b7
 ,eligibility ,a vet]an describ$ 9 ?is  
p>agraph is-- 7,a7 a vet]an :o is at    
increas$ risk ( brea/ canc] 7z det]m9$ 9
 accordance ) ! mo/ rec5t applicable    
,am]ican ,college ( ,radiology          
,appropriat5ess ,crit]ia or ! mo/ rec5t 

applicable guidel9es ( ! ,national      
,compreh5sive ,canc] ,network7 or )     
het]og5e\sly or extremely d5se brea/    
tissue 7z def9$ by ! ,brea/ ,imag+      
,report+ & ,data ,sy/em e/abli%$ by !   
,am]ican ,college ( ,radiology71 )\t    
reg>d to :e!r ! vet]an is enroll$ 9 !   
sy/em ( annual pati5t enrollm5t e/abli%$
 & op]at$ "u section #agje7;a7 ( ?is    
title2 or  7,b7 a vet]an :o is n        
describ$ 9 subp>agraph 7,a7 & :o is     
det]m9$ by a heal? c>e provid] 79       
accordance ) su* mo/ rec5t applicable   
crit]ia or guidel9es7 to require scre5+ 
or diagno/ic brea/ imag+ by reason (    
factors includ+ age1 race1 e?nicity1 or 
p]sonal or family m$ical hi/ory1 )\t    
reg>d to :e!r ! vet]an is enroll$ 9 !   
sy/em ( annual pati5t enrollm5t e/abli%$
 & op]at$ "u section #agje7;a7 ( ?is    
title4  7b7 ,prohibition on co/-,%>+    
,not)/&+ subsections 7f7 & 7g7 ( section
 #agaj & section #agbb;,a ( ?is title1 !
 ,secret>y may n require any vet]an     
describ$ 9 p>agraph 7#b7 ( subsection   

7a7 to make any copaym5t =1 or *>ge !   
vet]an = any o!r co/ (1 ! receipt ( any 
item or s]vice furni%$ pursuant to      
p>agraph 7#a7 ( su* subsection4  4  7#b7
 ,cl]ical am5dm5t ,! table ( sections at
 ! beg9n+ ( su* *apt] is am5d$ by ins]t+
 aft] ! item relat+ to section #agbj;,j 
! foll[+ new item3  #agbj,k4 ,brea/     
scre5+s = c]ta9 individuals at increas$ 
risk = brea/ canc]4  4  7#c7 ,effective 
date ,! am5dm5ts made by ?is subsection 
%all take effect on ,janu>y #a1 #bjbf4